1.
Multiple Treatment Meta-Analysis of Intra-Articular Injection for Temporomandibular Osteoarthritis.
Liu, Y, Wu, JS, Tang, YL, Tang, YJ, Fei, W, Liang, XH
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2020;(3):373.e1-373.e18
Abstract
PURPOSE The purpose of the present study was to compare the efficacy of intra-articular injections of different agents for temporomandibular osteoarthritis (TMJOA) using a network meta-analysis. MATERIALS AND METHODS A comprehensive search strategy was performed in multiple English and Chinese language electronic databases. Randomized controlled trials comparing the effect of intra-articular injections of different agents to treat TMJOA were included in accordance with the inclusion and exclusion criteria. The bias of risk in each study was assessed, with data extraction performed independently by 2 reviewers. The primary outcomes included pain intensity and maximal mouth opening. RESULTS A total of 11 trials were included in the present study, and 10 different agents (ie, hyaluronic acid, dexamethasone, prednisolone, betamethasone, betamethasone plus hyaluronic acid, morphine, tramadol, platelet-derived growth factor [PDGF], placebo, arthrocentesis alone) administered using intra-articular injections were assessed. The evidence from the direct comparisons showed that arthrocentesis plus sodium hyaluronate resulted in significantly better pain relief outcomes compared with arthrocentesis alone. Also, the visual analog scale score was further reduced to 1.27 by PDGF injection after arthrocentesis (arthrocentesis plus PDGF) compared with arthrocentesis alone. Morphine and tramadol had a high probability of being the best treatment for pain control, with PDGF ranked third. When considering pain relief, arthrocentesis plus sodium hyaluronate resulted in a better outcome than arthrocentesis alone, and arthrocentesis plus PDGF was better than arthrocentesis plus placebo. PDGF injections had the greatest probability of being the best treatment for improving joint opening, followed by sodium hyaluronate. CONCLUSIONS Tramadol, morphine, and PDGF injections after arthrocentesis were effective in the treatment of TMJOA with excellent effects in reducing pain and improving joint opening. Hyaluronic acid injections were effective for improving the maximal mouth opening of patients with TMJOA in the short-term. The combination of a corticosteroid and hyaluronic acid injection reduced the symptoms of TMJOA more than corticosteroid injections alone, but not of hyaluronic acid alone.
2.
Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis.
Moldez, MA, Camones, VR, Ramos, GE, Padilla, M, Enciso, R
Journal of oral & facial pain and headache. 2018;(1):53–66
Abstract
AIMS: To assess the effectiveness of intra-articular injections of sodium hyaluronate (NaH) or corticosteroids (CS) for treatment of intracapsular temporomandibular disorders (TMD). METHODS Single- or double-blinded randomized controlled trials (RCTs) on the effectiveness of NaH or CS injections, compared to each other or to placebo, for the treatment of intracapsular TMD due to osteoarthritis and/or internal joint derangement were analyzed in this systematic review and meta-analysis. Electronic searches of MEDLINE through the PubMed, Web of Science, and Cochrane Library databases were conducted on March 17, 2015, and an updated search was conducted on June 7, 2017. Three reviewers independently extracted the data and assessed the risk of bias of included studies. RESULTS An initial search yielded 245 studies, and 5 additional studies were identified through cross referencing. A total of 22 studies were identified as relevant based on the abstracts, but only 7 RCTs met the inclusion criteria. Six of the included studies had unclear risk of bias, and one had high risk of bias. Four studies were eligible for meta-analysis. Pooled results showed no significant difference in short- or long-term pain improvement with NaH compared to CS. The number of responders to NaH was significantly more than placebo in one study, but not significantly higher than CS in another study. CONCLUSION Although there was no significant difference between the effectiveness of NaH and CS intra-articular injections, there was some evidence that NaH was better than placebo. Further research is needed to determine the minimum effective dose and long-term side effects of both injections.